[Answered] Critically analyze the proposition that India’s constitutional guarantee of a life with dignity must legally extend to dignity in dying. Examine the necessity of euthanasia reform.

Introduction

The World Health Organization (2023) estimates over 5.4 million Indians require palliative care annually. India’s Article 21 promise of “life with dignity” increasingly demands ethical and legal recognition of “dignity in dying.”

Constitutional and Ethical Context

1. The right to life under Article 21 of the Indian Constitution has evolved through judicial interpretation—from Maneka Gandhi v. Union of India (1978) to Common Cause v. Union of India (2018)—to encompass dignity, autonomy, and freedom of choice.
2. The Supreme Court in Common Cause legalized passive euthanasia and recognized advance directives, stating that the right to die with dignity is inseparable from the right to live with dignity.
3. However, the implementation gap persists. Procedural rigidity—dual medical boards, judicial oversight, and unclear hospital protocols—renders the process inaccessible. As a result, families and physicians often make informal decisions, undermining legality and transparency.

Rationale: Autonomy and Beneficence

From the bioethical perspective, passive euthanasia aligns with two key principles —

1. Autonomy: Respecting the patient’s informed choice to decline life-prolonging treatment.
2. Beneficence and Non-Maleficence: Preventing unnecessary suffering when medical intervention only extends pain.
3. However, active euthanasia (deliberate termination of life) remains ethically fraught. Given India’s socio-economic inequalities, limited healthcare access, and familial dependence, it risks coercive euthanasia—where financial or emotional pressures may influence end-of-life choices.

Comparative and Global Perspectives

1. Countries like Netherlands, Belgium, and Canada have legalized active euthanasia under strict safeguards. The U.K.’s Terminally Ill Adults Bill (2025) allows physician-assisted dying for those with less than six months to live.
2. Yet, India’s fragmented healthcare system, low palliative care penetration (only 2% of need met, Lancet Commission, 2022), and weak institutional capacity make full emulation of Western models ethically risky.
3. India’s approach—ethical conservatism with compassionate pragmatism is more contextually suited. The focus should be on refining passive euthanasia to ensure accessibility, accountability, and humane implementation.

Necessity of Reforming Passive Euthanasia

1. Digital Integration: A national digital registry for Advance Directives, linked with Aadhaar and verified by physicians, can streamline consent.
2. Decentralised Ethics Oversight: Empower Hospital Ethics Committees (including doctors, palliative specialists, and independent members) to approve withdrawal of life support within 48 hours.
3. Legal Simplification: Replace judicial clearance with statutory review mechanisms monitored by State Health Commissions.
4. Mandatory Safeguards: Cooling-off periods, psychological counselling, and family consent to prevent misuse.
5. Public Awareness and Medical Training: Medical curricula should integrate end-of-life ethics and palliative care law, reducing fear among healthcare professionals.

These reforms align with One Nation–One Health Record vision and India’s Digital Health Mission, ensuring ethical oversight through technological efficiency.

Way Forward: Dignity, Compassion, and Legal Certainty

India must move from legality to practicality ensuring that the terminally ill are neither forced to live in pain nor die without dignity. Euthanasia reform should prioritize procedural humanity, not legislative haste.

Conclusion

As Amartya Sen emphasized in “The Idea of Justice”, true freedom lies in expanding human capability. Ensuring dignified dying transforms law into compassion, fulfilling India’s constitutional and moral conscience.